Recent epidemiology suggests a link between periodontal health and systemic health, and several trials support this association. Research links periodontal disease to other health issues including heart disease, stroke, diabetes, pre-term low term birth weight, rheumatoid arthritis, and chronic kidney disease. Moreover, periodontal disease often results in chronic inflammatory response to bacterial infection in the periodontal pockets.
An estimated 80% of adults in America have some form of periodontal disease that, if left untreated, could lead to tooth loss. Periodontal disease, including gingivitis and periodontitis, is a chronic bacterial infection that affects the gums and bone surrounding and supporting the teeth.
In an initial form of periodontal disease (gingivitis), the gums redden, swell and bleed easily. If left untreated, gingivitis can lead to periodontis, which is caused by plaque bacteria spreading and growing below the gum line. This bacteria irritates the gums, which in turn stimulates a chronic inflammatory response in which the gums separate from the teeth, deepening periodontal pockets (spaces between the teeth and gums that frequently become infected), and allowing the infection to advance.
Professional scaling and root planing are necessary to remove the attached bacteria from the surface of the roots. However, additional home care between professional treatments is helpful to maintain periodontal health. Traditional oral cleansing tools such as toothbrushes and dental floss are useful for maintaining periodontal health of already-healthy gums. However, these traditional tools are limited in that they generally can clean pockets only up to approximately 2-3 mm in depth. Gum inflammation, loss of epithelial attachment between the gums and teeth, and/or deterioration of the alveolar process caused by periodontitis results in deepening of the periodontal pockets, so that brushing and flossing are no longer sufficient to fully cleanse the pockets.
Subgingival irrigation with an antimicrobial agent helps to disrupt bacterial colonization between professional treatments, even in relatively deep periodontal pockets. Moreover, irrigation is a useful procedure in controlling inflammation and keeping tissue healthy between professional periodontal therapies. Thus, supragingival and subgingival irrigation is effective at helping control gingivitis and periodontitis. However, the overwhelming challenge for treatment is to encourage patient compliance with regular professional and home care.
Generally, research has been devoted to variable pulsing irrigation that delivers a great volume of fluid in a relatively non-directed manner that is analogous to rinsing. While such a system may be capable of delivering relatively large quantities of high-pressure fluid, it is economically impractical to employ such a system with a relatively high-cost chemotherapeutic cleansing fluid. Thus, there is a need for a delivery system that accurately delivers a precisely measured quantity of chemotherapeutic fluid in a directed manner for patient use.